C/T Ratio letter

[CalabroJ]

After a review of 2008 C/T ratios for all our physicians, I have found a few in need of a letter per my pathologist. I am relatively new at this position. I was wondering if any of you had a form letter you might be able to e-mail me that "gently" covers this issue? Thanks!

Joe

[Bill]

1. Any letter sent should be sent by the Transfusion Committee, "The Transfusion Committee reviewed the C/T ratio's for the year 2008 by individual ordering clinician... This review was performed according to state and/or national regulatory standards." This lets the clinician know that none of this is personal.

2. Give the aggregate C/T ratio and the individual's C/T ratio. Also, you might note the C/T ratio for the clinician's medical specilty and that others in the specility were xxx & yyy, etc without naming any individuals.

3. Depending on what you wish to accomplish, depends how you might word the remainder. Do you want an explaintion (response) as to why or is the committee just trying to give information to the ordering clinician hoping that the clinician will alter ordering patterns.

4. If this information is to become part of the clinician's permanent record for creditialing information remind him/her where records are kept and for how long.

Have fun with the new position.

Edited January 10, 2009 by Bill

[NedB]

Individual C/T ratios are not important. Check the Technical Manual. It is more important to prepare a list of recommended number of units for specific types of surgery and to establish a threshhold for transfusions (Hct: 30, Hgb: 10 for example) and to have these approved and promulgated by the Transfusion Committee. Once established, the Blood Bank sould monitor individual transfusions. For example, Orthopedic surgeons who do knee replacements will not do surgery without 2 units on hand, but then seldom use the two unless they were autologous. This is not a burden on the Blood Bank, and is naturally commendable.

Finally, you do not want to take an antagonistic approach to individual infractions. It would be better to request clarification of a specific circumstance. After all, you probably weren't there, and the clinician probably was or else was given infromation from someone who was, the nurse who observed the blood in the dressing, or the Patient's blood pressure or color. Once your Medical Director gets the details of the response, the Transfusion Committee can decide how to proceed.

Of the things presented here, the most involved is the list of recommended units for surgery. You would need cooperation from the head of surgery and the leading surgeons.

On the other had, the threshhold for transfusions is an accepted level; although there are studies that show we should use lower numbers and different threshholds based on age, sex and condition.